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Updated: Jul 23, 2026
Use of Electromagnetic Navigational Transthoracic Needle Aspiration E-TTNA for Sampling of Lung Nodules
Published on: May 23, 2015
Risk factors and intraoperative identification of non-lepidic predominant lung adenocarcinoma presenting as subsolid
Donglai Chen1, Qifeng Ding2, Yongzhong Li2
1Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Background:
The purpose of this study was to assess the prognostic factors for non-lepidic invasive adenocarcinoma presenting as subsolid nodules. The feasibility of detecting non-lepidic predominant patterns on frozen section (FS) was also evaluated.
Methods:
A multicenter retrospective cohort of 614 patients with clinical T1N0M0 non-lepidic invasive adenocarcinoma presenting as subsolid nodule was included. Two subgroups were divided based on the consolidation-to-tumor ratio (CTR) on lung window: ground glass opacity (GGO)-dominant subgroup (CTR<0.5), solid-dominant subgroup (CTR≥0.5). Kaplan-Meier approach and multivariable Cox models were used to identify risk factors for recurrence-free survival (RFS) and overall survival (OS). FS and final pathology (FP) of 100 specimens were also reviewed by five pathologists for tumor grading synchronously.
Results:
Multivariate analysis indicated that segmentectomy was a risk factor for shortened RFS and OS in the solid-dominant subgroup rather than in the GGO-dominant one. Subset analysis demonstrated survival disadvantages of segmentectomy for high-grade adenocarcinoma but not for intermediate-grade one in the solid-dominant subgroup. However, segmentectomy exhibited non-inferiority to lobectomy in the GGO-dominant subgroup irrespective of tumor grade. The overall accuracy of identifying non-lepidic patterns was 84 % with a good interobserver agreement. Multivariable logistic analysis identified presence of complex glandular pattern and acinar pattern as independent predictors of the discrepancy between FS and FP.
Conclusions:
Segmentectomy should be cautiously performed for patients with radiologically solid-dominant non-lepidic invasive adenocarcinoma, especially for those with high-grade patterns. FS had high diagnostic accuracy and satisfactory interobserver agreement for tumor grading, which might aid surgeons in determining the appropriate surgical procedure.
